Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
Europace. 2018 Mar 1;20(3):512-519. doi: 10.1093/europace/euw406.
Ventricular tachycardia (VT) substrate ablation is based on detailed electroanatomical maps (EAM). This study analyses whether high-density multielectrode mapping (MEM) is superior to conventional point-by-point mapping (PPM) in guiding VT substrate ablation procedures.
This was a randomized controlled study (NCT02083016). Twenty consecutive ischemic patients undergoing VT substrate ablation were randomized to either group A [n = 10; substrate mapping performed first by PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or group B [n = 10; substrate mapping performed first by MEM and second by PPM ablation guided by MEM]. Ablation was performed according to the scar-dechanneling technique. Late potential (LP) pairs were defined as a Navistar-LP and a PentaRay-LP located within a three-dimensional distance of ≤ 3 mm. Data obtained from EAM, procedure time, radiofrequency time, and post-ablation VT inducibility were compared between groups. Larger bipolar scar areas were obtained with MEM (55.7±31.7 vs. 50.5±26.6 cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7±7.9 minutes) and PPM (25±9.2 minutes); P = 0.222. No differences were observed in the number of LPs identified within the scar by MEM vs. PPM (73±50 vs. 76±52 LPs per patient, respectively; P = 0.965). A total of 1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was significantly lower (0.58±0.4 vs. 1.64±1.1; P = 0.01) and radiofrequency time was shorter [median (interquartile range) 12 (7-20) vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT inducibility after procedure.
MEM with PentaRay catheter provided better discrimination of LPs due to a lower sensitivity for far-field signals. Ablation guided by MEM was associated with a shorter radiofrequency time.
室性心动过速（VT）的消融基于详细的电解剖图（EAM）。本研究旨在分析高密度多电极标测（MEM）是否优于传统的逐点标测（PPM），以指导 VT 基质消融程序。
这是一项随机对照研究（NCT02083016）。连续 20 例缺血性 VT 患者接受 VT 基质消融，随机分为 A 组（n=10；首先进行 PPM（Navistar）基质标测，然后进行 MEM 标测[由 PPM 引导的 PentaRay 消融]）或 B 组（n=10；首先进行 MEM 基质标测，然后进行 MEM 引导的 PPM 消融）。消融采用瘢痕去传导技术进行。晚期电位（LP）对定义为 Navistar-LP 和 PentaRay-LP，它们位于三维距离内，距离不超过 3mm。比较两组之间 EAM 获得的数据、手术时间、射频时间和消融后 VT 的可诱导性。使用 MEM 获得更大的双极瘢痕面积（55.7±31.7 与 50.5±26.6cm2；P=0.017）。MEM 与 PPM 的基质标测时间相似（19.7±7.9 分钟与 25±9.2 分钟；P=0.222）。MEM 与 PPM 识别瘢痕内 LP 的数量无差异（每个患者分别为 73±50 与 76±52 个 LP；P=0.965）。共分析了 1104 对 LP。使用 PentaRay，远场/LP 比值显著降低（0.58±0.4 与 1.64±1.1；P=0.01），射频时间更短[中位数（四分位距）12（7-20）与 22（17-33）分钟；P=0.023]。术后 VT 的可诱导性无差异。
PentaRay 导管的 MEM 提供了更好的 LP 鉴别，因为其对远场信号的敏感性较低。MEM 引导的消融与较短的射频时间相关。
